Cancer mortality in Italy.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to P Boyle.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The role of anthropometric variables in the risk of breast cancer has been investigated using pooled data from 2 hospital-based case-control studies conducted in Italy for a total data-set of 3,247 cases and 3,263 controls. No association was observed in pre-menopausal women between breast cancer risk and height, weight, indices of body mass (W/H2; W/H1.5) and surface area. In post-menopausal women, the risk of breast cancer was inversely related to height, being 0.8 in taller women (greater than 165 cm) compared with women 155 cm tall or less; the trend in risk, although not constantly decreasing, was statistically significant (p trend = 0.03). A direct, statistically significant association emerged with weight and indices of body mass and post-menopausal breast cancer risk. Considering 2 indices of body weight (W/H2 and W/H1.5) and relative to thinner women, the respective estimated risks of post-menopausal breast cancer increased to 1.4 and 1.3 for grossly obese women, and the corresponding p values for trend were respectively 0.002 and 0.02. The role of overweight was more evident in women with early age at menopause, thus suggesting a duration-risk effect.
The relationship between self-reported height and cancer risk was investigated in an integrated series of case-control studies including 273 cases of cancer of the oesophagus, 474 of the stomach, 558 of the colon, 352 of the rectum, 227 of the liver, 267 of the pancreas, 110 of the larynx, 2,388 of the breast, 545 of the cervix uteri, 563 of the endometrium, 688 of the ovary, 80 of the prostate, 263 of the bladder, 105 of the kidney, 43 Hodgkin's disease, 152 non-Hodgkin's lymphomas, 109 multiple myelomas, and a total of 5,574 controls admitted to hospital for acute, non-neoplastic conditions. No significant positive trend in risk was observed for any of the cancer sites considered, and some suggestion of elevated risks for the upper quintile of height was observed only for prostate (relative risk, RR = 1.4), kidney (RR = 2.7) and colon (RR = 1.2) in males (but not in females). For breast cancer, all the RRs for subsequent quintiles of height were close to unity. Four neoplasms showed significant inverse trends with height: oesophagus (RR = 0.7 for highest vs. lowest quintile), cervix (RR = 0.4), endometrium (RR = 0.7) and ovary (RR = 0.6). For oesophagus and cervix the trends could be explained, at least in part, in terms of social class correlates (multivariate RR 0.8 and 0.5, respectively), while for endometrium they could possibly be related to an inverse correlation between height and body mass (multivariate RR 0.9). Thus, our study did not support the hypothesis that nutrition in childhood and adolescence (which in this population is a determinant of adult height) is directly related to the subsequent risk of cancer at several major cancer sites. A number of inverse associations emerged, which may be either spurious and incidental, or suggest that poorer nutrition early in life may be an unfavourable indicator of the subsequent risk of selected neoplasms.
A case-control study on prostatic cancer was conducted in Kyoto, Japan, from 1981-1984, including 100 patients with prostatic cancer (PC) and age, hospital, and date-of-admission matched controls of benign prostatic hyperplasia (BPH) patients and general hospital patients. Analysis of several sexual factors obtained through a self-administered questionnaire revealed the following observations: 1) cancer patients had fewer sex partners before marriage (relative risk, RR = 0.35; 95% confidence interval: 0.13-0.93) than the hospital controls; 2) they had more vigorous sexual activities in the third (RR = 2.89; 1.01-8.28) and fourth decades of life (RR = 2.26: 1.03-4.95) than hospital controls, but no significantly different sexual activities from controls in other decades; 3) they had less frequent orgasms (RR = 2.55; 1.11-5.83) than BPH controls or (RR = 4.96: 1.78-13.9) hospital controls, and sexual intercourse appeared to be less satisfactory (RR = 2.08: 1.05-4.13) than that of hospital controls; and 4) they had less frequent episodes of sexually transmitted diseases (RR = 0.36: 0.16-0.83) than BPH controls. Marital status, fertility, ejaculation, masturbation, nocturnal emission, contraceptive use, and wife's episodes of sexually transmitted disease were not linked to prostatic cancer risk.
A case-control study of oral cancer was conducted in Beijing, People's Republic of China (PRC). The study was hospital-based and controls were hospital in-patients matched for age and gender with the cases. The response rates for cases and controls were 100 percent and 404 case/control pairs were interviewed. Tobacco smoking and alcohol consumption emerged as independent risk factors for oral cancer. For tobacco smoking, the association was considerably stronger for smokers of pipes than for smokers of cigarettes. For all kinds of tobacco, expressed as cigarette equivalents, the odds ratio (OR) for total pack-years smoked, among males, rose from 1.0 in never-smokers to 3.7 (95 percent confidence interval, 1.8-7.4) in the highest quintile of exposure. Similar results were found for females. The association with tobacco consumption was strong for squamous cell carcinoma but there was no trend in risk associated with tobacco for adenocarcinomas and other histologic types. So few women reported consuming alcohol that this variable could be examined only in males. Risk in the highest category of total lifetime intake of alcohol relative to that in lifetime abstainers was 2.3 (1.1-4.8) with a significant trend in risk with increasing dose (P less than 0.002). The combined effects of tobacco and alcohol appear to be approximately multiplicative in males. The attributable risk of oral cancer for tobacco among tobacco smokers was estimated as 34 percent (45 percent among males and 21 percent among females); for alcohol consumption in males the estimate was 23 percent.
Age-specific mortality rates from esophageal cancer in men are considered by year of birth in European countries with different levels of alcohol consumption. In countries with high and increasing levels of alcohol consumption (Denmark, Hungary, Federal Republic of Germany, and Czechoslovakia) successive birth cohorts born after about 1910 experience increasing mortality from esophageal cancer in all age-groups. No clear trend in esophageal cancer mortality was observed in countries starting from lower levels of alcohol consumption, even in the presence of increasing consumption (Sweden, Norway, Finland, Netherlands, Poland, UK). There was an apparent threshold around 8 l of ethanol per capita per year. Likewise, no upward trend in esophageal cancer mortality was observed in countries with high and stable alcohol consumption (France, Italy, Portugal). These findings are in agreement with results of analytic epidemiologic studies which indicate that esophageal cancer mortality is only slightly affected by moderate doses of alcohol, but rises steeply with consumption of large quantities. The incidence and mortality of esophageal cancer is likely to increase further in the future in countries where the level of alcohol consumption was relatively high in 1960 and where consumption increased further in the 1960s and 1970s.
A case-control study of oral cancer was conducted in Beijing, People's Republic of China. The study was hospital-based and controls were hospital in-patients matched to the cases by age and gender. A total of 404 case/control pairs were interviewed. This paper provides data regarding oral conditions as risk factors for oral cancer, with every patient having an intact mouth examined (pre-operation among cases) using a standard examination completed by trained oral physicians. After adjustment for tobacco smoking and alcohol consumption, poor dentition--as reflected by missing teeth--emerged as a strong risk factor for oral cancer: the odds ratio (OR) for those who had lost 15-32 teeth compared to those who had lost none was 5.3 for men and 7.3 for women and the trend was significant (P less than 0.01) in both genders. Those who reported that they did not brush their teeth also had an elevated risk (OR = 6.9 for men, 2.5 for women). Compared to those who had no oral mucosal lesions on examination (OR = 1.0), persons with leukoplakia and lichen planus also showed an elevated risk of oral cancer among men and women. Denture wearing per se did not increase oral cancer risk (OR = 1.0 for men, 1.3 for women) although wearing metal dentures augmented risk (OR = 5.5 for men). These findings indicate that oral hygiene and several oral conditions are risk factors for oral cancer, independently of the known risks associated with smoking and drinking.
In order to project trends in mortality from 11 major cancer sites in Switzerland to the end of the current century, a log-linear Poisson age/period/cohort model with arbitrary constraints on the parameters was used, fitted to the observed rates for the period 1950-84. One projection was based on the assumption of a total absence of change in the effect of period, the second was based on a linear extrapolation of the logarithms of the seven known periods, and the third was related to a series of a priori external epidemiological hypotheses, whenever available. For instance, coefficients below unity were used for lung and other tobacco-related neoplasms in men, since some decline in exposure to tobacco carcinogens was observed among Swiss men, and above unity for women since the prevalence of smoking has risen among successive generations of women. Although the method has limitations and uncertainties, several qualitative indications could be derived from this exercise. For instance, the various models suggest that the age-standardized mortality from oral cancer in men will probably increase up to the end of the century, even under the optimistic assumption of an appreciable decline in smoking, while cancer of the oesophagus is likely to level-off around current values, as other tobacco-related neoplasms, prostate cancer in men, and breast cancer in women will probably do. Some steady decline is predicted by various models fitted to the incidence of stomach and intestinal cancer in both sexes, and to ovarian cancer. Lung cancer will continue to rise in women but will stop rising in men, and it will possibly fall if the hypothesis of a decline in exposure to tobacco carcinogens proves correct. Although any prediction has, by definition, substantial difficulties and uncertainties, projections of cancer mortality in the near future are based on a substantial amount of information already available, and may offer valuable information for epidemiological inferences and health planning purposes.
Explore the source record for details and available documents.
The relation between cigarette smoking and risk of bladder cancer was analysed in a case-control study in Northern Italy of 337 cases of histologically confirmed invasive bladder cancer and 392 controls admitted to the same network of hospitals with acute, non-neoplastic, non-urological conditions. Compared with never-smokers, the multivariate relative risk (RR) was 1.9 (95% confidence interval, CI 1.2-3.1) for ex-smokers and 3.3 (95% CI 2.2-5.0) for current smokers. The risk was directly and significantly related to duration of smoking (RR 3.5 for 30 years or more) and dose (RR 3.9 for 20 cigarettes per day or more), and consistent among strata of sex and age (though the RRs were systematically higher at older ages). Smokers of black tobacco only had a RR of 3.7, compared with 2.6 for smokers of blond cigarettes or mixed types. The interaction between tobacco and several occupations associated with bladder cancer risk fitted an additive rather than a multiplicative model: compared with non-exposed never-smokers, RR was 2.5 for exposed non-smokers, 2.8 for non-exposed smokers and 3.7 for occupationally exposed smokers.
The relation between history of several medical conditions and procedures and risk of breast cancer was evaluated in data from a hospital-based case-control study of 2663 cases of breast cancer and 2344 controls with acute conditions unrelated to any of the established or potential risk factors for breast cancer. Whereas previous diagnosis of diabetes mellitus, thyroid disease, hypertension at any age, hyperlipidaemia, cholelithiasis, pelvic inflammatory disease and physician-diagnosed subfertility were unrelated to cancer risk, history of severe obesity in postmenopausal women (odds ratio [OR] 1.4), benign breast disease (OR 1.8) and history of breast biopsies (OR 2.4) were associated with significant risk elevation. Conversely, lifelong history of menstrual irregularities (OR 0.6) seemed to confer some protection against onset of breast cancer. This study supports the hypothesis that, unlike endometrial cancer, breast cancer risk is not enhanced by medical conditions known or suspected to be linked with female hormones, with the exception of benign breast disease and severe overweight in postmenopausal women.
Explore the source record for details and available documents.
The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case-control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0-1.8) and 1.2 (0.8-1.7) for stomach, 1.0 (0.8-1.3) and 1.1 (0.8-1.5) for colon, and 1.2 (0.9-1.6) and 0.9 (0.6-1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.
The relation between various aspects of medical history, selected indicator foods and the risk of pancreatic cancer was analyzed in a hospital-based case-control study conducted in Northern Italy on 247 patients with cancer of the pancreas, and 1,089 controls in hospitals for acute, nonneoplastic or digestive conditions. There was a significant association with history of pancreatitis (relative risk, RR 3.2, 95% confidence interval = 1.3-7.9), which was however reduced when the condition was first diagnosed at least 5 years previously. The point estimates were slightly, but not significantly, above unity for diabetes (RR = 1.5), gastrectomy (RR = 1.1) and cholelithiasis (RR = 1.3), and no association was found with liver disease or drug allergy. In relation to diet, there was some tendency for the risk to decrease with more frequent fruit consumption, but the results were largely inconsistent in relation to various indicators of meat, animal protein or fat intake. Although no important associations were found in this study with various aspects of medical history or diet indicators and pancreatic cancer risk, on account of the size of the dataset and the statistical power, this study contributes usefully to the debate on a common cancer whose causes are still largely undefined.
The oral cavity and pharynx combined is the sixth commonest site of cancer in both sexes. In many countries the mortality rate is increasing among younger men born since approximately 1910-1920. A causal role in the aetiology of mouth cancer has been established for tobacco use, both smoking and chewing, separately and in conjunction with betel-quid chewing; with alcohol consumption and, less certainly, with other factors such as poor oral hygiene, nutritional factors and certain occupational exposures. In Western countries, there is convincing evidence that a large attributable risk can be ascribed to the joint habits of cigarette smoking and alcohol consumption. In Asian societies, a high attributable risk can be ascribed to cigarette smoking and betel chewing. Mouth cancer is at the same time an important form of cancer, and one for which practical prospects for prevention already exist. Against this background of a continually increasing trend among younger persons, it seems essential to engage upon programmes of prevention, including increasing awareness for early detection, against mouth cancer at the present time.
Explore the source record for details and available documents.
Explore the source record for details and available documents.